套扎术与硬化术治疗食管静脉曲张出血疗效比较

Comparative study of endoscopic variceal ligation and endoscopic variceal sclerotherapy in treatment of variceal hemorrhage

目的评价食管静脉曲张套扎治疗(EVL)、硬化治疗(EVS)及两者联合治疗肝硬化引起的食管静脉曲张破裂出血患者的临床疗效。方法回顾性分析我院86例行食管静脉曲张内镜下治疗的肝硬化患者的临床资料,根据当时随机选择的治疗方法将资料分为3组,EVL组(36例)、EVS组(28例)及套扎联合硬化治疗组(22例)。对3组患者治疗后静脉曲张消失情况及再出血情况进行列联表分析卡方检验。结果 EVL组、EVS组及联合治疗组的静脉曲张消失率分别为58%(21/36)、46%(13/28)、86%(19/22)。3组治疗后静脉曲张消失率比较,联合组高于其他两组,差异有统计学意义(χ2=8.59,P<0.05);3组随访1年再出血率分别为25%(9/36)、11%(3/28)、5%(1/22)。联合治疗组较套扎组1年再出血率低,差异有统计学意义(χ2=4.00,P<0.05)。结论 EVL、EVS以及联合治疗都能有效治疗和预防食管静脉曲张破裂出血,但联合治疗曲张静脉消失率效果明显优于其他两种方法,且联合治疗组的1年再出血率低于单一套扎组。

Objective To assess the efficacy of endoscopic variceal ligation（EVL）,endoscopic variceal sclerotherapy（EVS）and the combined treatment in control of the esophageal varices.Methods Eighty-six cases of patients with esophageal varices bleeding were assigned with endoscopic therapy.According to the time of a random selection of treatment methods data were divided into 3 groups,namely the ligation group（EVL）,the sclerotherapy group（EVS）and the combined treatment group.Analysis the three groups of patients after treatment of varices disappeared and rebleeding of contingency table analysis chi-square test.Results The rates of varicose disappear in EVL group ,EVS group and the combined treatment group were respectively 58%（21/36）,46%（13/28）,86%（19/22）.There are obviously differents of the rate of varicose disappear among the three group above ,and the combined treatment group is the hignest.The difference was statistically significant（χ2=8.59,P0.05）;The re-bleeding rate of three groups were respectively 25%（9/36）,11%（3/28）,5%（1/22）.The re-bleeding rate of combination group was lower than the EVL group in the follow year,the difference was statistically significant（χ2=4.00,P0.05）.Conclusion The combination of EVL and EVS is the best effective method for esophageal varices,although EVL or EVS alone is effective in control active,recurrence of bleeding.